Early identification of HCV genotype 1 patients responding to 24 weeks peginterferon α‐2a (40 kd)/ribavirin therapy

Approximately one third of hepatitis C virus (HCV) genotype 1 patients achieved a sustained virological response (SVR) after 24 weeks of treatment with peginterferon α‐2a (40 kd) plus ribavirin in a randomized, multinational trial. We aimed to identify factors associated with a rapid virological response (RVR) at week 4 (HCV RNA <50 IU/mL) and a SVR (HCV RNA <50 IU/mL at the end of follow‐up) in these patients. Stepwise multiple logistic regression analysis was used to explore the prognostic factors for a RVR and SVR in genotype 1 patients treated for 24 weeks. Fifty‐one of 216 (24%) genotype 1 patients in the 24‐week treatment groups had a RVR. SVR rates were considerably higher in patients with than without a RVR (89% vs. 19%, respectively). Patients with a baseline HCV RNA of less than 200,000 IU/mL (OR 9.7, 95% CI 4.2‐22.5; P < .0001) or 200,000‐600,000 IU/mL (OR 3.6, 95% CI 1.5‐9.1; P = .0057) were more likely to achieve a RVR than those with HCV RNA greater than 600,000 IU/mL. HCV subtype (1b vs. 1a) was also independently associated with RVR (OR 1.8, 95% CI 0.9‐3.7; P = .0954). RVR (OR 23.7 vs. no RVR, 95% CI 9.1‐61.7) and baseline HCV RNA less than 200,000 IU/mL (OR 2.7 vs. >600,000 IU/mL, 95% CI 1.1‐6.3; P < .026) were significant and independent predictors of SVR in patients treated for 24 weeks. In conclusion , patients infected with HCV genotype 1 and treated with peginterferon α‐2a/ribavirin sustained a RVR 24% of the time. This portends an 89% probability of a SVR after 24 weeks of treatment. (H EPATOLOGY 2006;43:954–960.)